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This is VAERS ID 541266

History of Changes from the VAERS Wayback Machine

First Appeared on 12/14/2014

VAERS ID: 541266
VAERS Form:
Age:13.0
Gender:Male
Location:Foreign
Vaccinated:2014-05-28
Onset:2014-05-28
Submitted:2014-08-27
Entered:2014-08-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. J015338 / - UN / IM

Administered by: Other      Purchased by: Other
Symptoms: Retching, Syncope, Vomiting

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: No other medications
Current Illness: Unknown
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': WAES1408AUS014760

Write-up: Information was obtained on a request by the company from the agency (agency # OPR341453) via a Public Case Detail concerning a 13 year old male patient. On 28-MAY-2014, the patient was vaccinated with GARDASIL lot # J015338, expiration date 11-APR-2016, 1 dose unspec as necessary, intramuscular. On 28-MAY-2014, the patient became unwell with dry reaching, then vomited and had a collapse. The outcome of dry reaching, vomited and had a collapse was reported as not yet recovered. The patient was on observation. The agency considered the events to be possibly related to GARDASIL. The agency considered the events as incapacitating/disabling. This was originally reported by a general practitioner. Additional information is not expected.


Changed on 9/14/2017

VAERS ID: 541266 Before After
VAERS Form:(blank) 1
Age:13.0
Gender:Male
Location:Foreign
Vaccinated:2014-05-28
Onset:2014-05-28
Submitted:2014-08-27
Entered:2014-08-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. J015338 / - UNK UN / IM

Administered by: Other      Purchased by: Other
Symptoms: Retching, Syncope, Vomiting

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: No other medications
Current Illness: Unknown
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': WAES1408AUS014760

Write-up: Information was obtained on a request by the company from the agency (agency # OPR341453) via a Public Case Detail concerning a 13 year old male patient. On 28-MAY-2014, the patient was vaccinated with GARDASIL lot # J015338, expiration date 11-APR-2016, 1 dose unspec as necessary, intramuscular. On 28-MAY-2014, the patient became unwell with dry reaching, then vomited and had a collapse. The outcome of dry reaching, vomited and had a collapse was reported as not yet recovered. The patient was on observation. The agency considered the events to be possibly related to GARDASIL. The agency considered the events as incapacitating/disabling. This was originally reported by a general practitioner. Additional information is not expected.


Changed on 2/14/2018

VAERS ID: 541266 Before After
VAERS Form:1
Age:13.0
Gender:Male
Location:Foreign
Vaccinated:2014-05-28
Onset:2014-05-28
Submitted:2014-08-27
Entered:2014-08-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. J015338 / UNK UN / IM

Administered by: Other      Purchased by: Other
Symptoms: Retching, Syncope, Vomiting

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: No other medications
Current Illness: Unknown
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': WAES1408AUS014760

Write-up: Information was obtained on a request by the company from the agency (agency # OPR341453) via a Public Case Detail concerning a 13 year old male patient. On 28-MAY-2014, the patient was vaccinated with GARDASIL lot # J015338, expiration date 11-APR-2016, 1 dose unspec as necessary, intramuscular. On 28-MAY-2014, the patient became unwell with dry reaching, then vomited and had a collapse. The outcome of dry reaching, vomited and had a collapse was reported as not yet recovered. The patient was on observation. The agency considered the events to be possibly related to GARDASIL. The agency considered the events as incapacitating/disabling. This was originally reported by a general practitioner. Additional information is not expected.


Changed on 6/14/2018

VAERS ID: 541266 Before After
VAERS Form:1
Age:13.0
Gender:Male
Location:Foreign
Vaccinated:2014-05-28
Onset:2014-05-28
Submitted:2014-08-27
Entered:2014-08-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. J015338 / UNK UN / IM

Administered by: Other      Purchased by: Other
Symptoms: Retching, Syncope, Vomiting

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: No other medications
Current Illness: Unknown
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': WAES1408AUS014760

Write-up: Information was obtained on a request by the company from the agency (agency # OPR341453) via a Public Case Detail concerning a 13 year old male patient. On 28-MAY-2014, the patient was vaccinated with GARDASIL lot # J015338, expiration date 11-APR-2016, 1 dose unspec as necessary, intramuscular. On 28-MAY-2014, the patient became unwell with dry reaching, then vomited and had a collapse. The outcome of dry reaching, vomited and had a collapse was reported as not yet recovered. The patient was on observation. The agency considered the events to be possibly related to GARDASIL. The agency considered the events as incapacitating/disabling. This was originally reported by a general practitioner. Additional information is not expected.

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